Woman's health problems creating a cycle of despair

August 22, 2002|By MICHAEL OLESKER

IN THE MORNING, Jackie Tessmer opens her eyes and sees the wheelchair beside her bed. It is her monument to doomed expectations. She slides herself painfully into the wheelchair. The children need breakfast. The rent has to be paid, with money that isn't there. The depression hangs over everything like a shadow that never goes away.

She is 44 years old and running out of energy, and hope, and it shouldn't be like this for anyone in the richest nation on earth. She has had cerebral palsy since birth, and a year ago underwent a laminectomy -- a disabling, "last resort" operation removing the covering of her spinal cord -- and now there are ulcers on her legs from a combination of diabetes and a compound ankle fracture she suffered three years ago. She is partly paralyzed from the waist down, and wholly paralyzed financially.

The numbers are awful. Once, Tessmer says, "I was a thriving, working single mother." Living in Rosedale, in northeastern Baltimore County, she made $7.50 an hour doing data entry work before her health problems worsened. The money was enough to keep things together. She had the foresight to buy a disability policy while she could still work. The policy pays her $801 a month. She and the two kids, Stephanie and Joe, each 13, born less than a year apart, have to get by on that money.

It amounts to $9,612 a year. Rent and utilities, she says, eat up roughly $7,800 of that. Of the remaining $1,800, she has to find money for food and clothing -- and for medical help.

"This," says Dr. Ronald Byank, an orthopedic surgeon at Johns Hopkins Bayview Medical Center who has treated Tessmer, "is a very nice lady who's had a whole host of medical problems, from cerebral palsy to diabetes. And she doesn't have money, and she's had problems with Medicaid, and I wish I could say it's unusual but it's not. There are lots of people with serious medical problems that can't be handled because of money. She's not unique. She's one of many."

Here is what it's like for Tessmer: "I get six months of Medicaid at a time, but twice a year I'm supposed to pay what's called a spend-down deductible" -- that's $2,100, twice a year -- "to get recertified for my Medicaid coverage.

"Given my poverty-level income, there is no way for me to actually pay that amount, so I simply submit the bills to Medicaid so it will begin to cover me for six months after I have `met' the deductible. Plus, it takes me time to amass medical bills of $2,100 in the first place, and it's even more difficult given that most doctors won't see me because I don't have the coverage or the money to pay the medical bills."

"She's described it exactly right," says Dr. Sohail Qarni, Tessmer's family physician. "And that's the problem with our system. It's not just Jackie Tessmer, it's lots of people like her. I see these problems almost every day. People with chronic medical problems, and the insurance troubles, and the bureaucracy after bureaucracy.

"Nobody's providing financial assistance. Nobody's helping with a simple act like driving to medical offices. Jackie needs medications and lab tests. She needs to be seen regularly. And our society has failed her completely."

(Telephone calls to Tessmer's Medicaid office were received by a tape recording informing callers that queries would be answered "in the next 24 hours.")

So Tessmer plods through the days. Sometimes neighbors help by picking up groceries. A lady from church drops in once a week. There are no relatives, beyond the two children, who can come to her assistance.

The children have more than enough to handle. When their mother underwent her laminectomy, they stayed with foster parents for months while Tessmer recuperated. With her legs ulcerated, the children have to tend her medical dressings.

"This is something for doctors to do," she says. "But you call a doctor, and the first thing they ask about is insurance. When you say you don't have any, they don't want to make an appointment." One hospital, she says, is suing her for overdue bills.

And all of this is translated into routine despair.

"I don't want to be a charity case," Tessmer says. She sits in a wheelchair and tries to compose herself between sentences. "I want to work for a living. I don't want to be society's burden. I don't want to be my children's burden. I want to be as healthy as possible. In other words, I want medical care, and I want pain management.

"I'm sorry," she says, pausing to compose herself again. "Sometimes I just get overwhelmed, and I cry. The rent's paid, so I'm on top of that. But I think of the kids. And then, this morning, we found little brown mice running through the apartment."

"A tragedy," says Dr. Qarni. "This is a young woman. Her mind is sharp, she still has years ahead of her. But what are those years going to be like?"